Healthcare Provider Details

I. General information

NPI: 1376956193
Provider Name (Legal Business Name): EMILIA VIGIL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

610 DOUGLAS MACARTHUR RD NW
ALBUQUERQUE NM
87107-5138
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5173
  • Fax:
Mailing address:
  • Phone: 505-459-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0195541
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCCMH0195541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: